A shortage of dermatologists has led to a proliferation of skin cancer clinics that are usually operated by general practitioners rather than specialists.
Photograph: Dan Himbrechts/AAP

Australians are being treated at skin cancer clinics by general practitioners who often lack training in detecting and treating cancers, medico-legal experts and dermatologists say.

Hundreds of thousands of Australians are treated for skin cancer every year but a shortage of dermatologists has seen a proliferation of clinics being opened across the country that are usually operated by general practitioners rather than specialists.

While some doctors have had additional training to detect skin cancers, and to properly treat those patients or refer them to specialists, other doctors running skin cancer clinics have received no extra training, or the training they have received lacks scientific and clinical rigour.

People need to learn sunscreen is last line of defence, Cancer Council stresses

Read more

The president of the Australasian College of Dermatologists, Dr Andrew Miller, said it was an issue his group had been “long aware of”.

The college did not have a course to offer GPs to gain expertise in skin cancer recognition but one was being developed, he said. It would take about a year to complete part-time and would be available some time this year.

“There are some skin cancer doctors who take their role very seriously and who attempt to maintain a high standard, but there is no Australian Medical Council training in skin cancer medicine other than if people become specialist dermatologists,” he said.

“The courses that are on offer vary in quality. People walk into a clinic and see a certificate on a wall, but they don’t know if it’s taken the doctor one year or one weekend to acquire it.”

Part of the issue was a lack of federal government funding for training positions for dermatologists, he said. According to Cancer Council Australia, two in three Australians will be diagnosed with skin cancer by the time they are 70, with more than 750,000 people treated for one or more non-melanoma skin cancers in Australia each year. There were not enough dermatologists to meet demand, creating an opportunity for entrepreneurial doctors to open skin cancer clinics, Miller said.

“Doing a skin cancer check is not a complicated thing and there is a lot of good evidence to show general practitioners are good at doing those checks,” he said.

“Where the complexity arises in some cases is in the decision as to what to do next and how to treat. That’s where you need the training. My view is that people’s family doctor should be doing the skin check as they can see there is something off and then they can decide whether the cancer can be managed in-house or whether the patient needs to be referred to a specialist because the cancer is in a tricky spot or more complex.”

He said even family GPs had been caught out by believing they were doing the right thing in referring patients to a skin cancer clinic staffed by GPs claiming to be skin cancer experts.

“The skin cancer clinics often don’t share treatment and results back with the family GP and, if a patient does get inadequate treatment, they return to their family GP who has to pick up the mess, and they feel really bad for having referred their patient there,” Miller said.

He added that he often treated patients who had been referred to him after their skin cancer had been improperly managed by doctors at skin cancer clinics.

“Skin cancer clinics by their nature encourage doctors to push the envelope of their expertise,” he said. “By doing skin cancer procedures, you can increase your income. Medicare is fantastic but one of its flaws is it rewards procedures like cutting out skin cancers with consultative medicine, which is time-consuming and involves talking to people and perhaps referring them on, is less lucrative.”

The chairwoman of Cancer Council Australia’s skin cancer committee, Heather Walker, said she was concerned by the lack of consistency in training and the range of competency in skin cancer detection and treatment. She was also concerned that some skin cancer clinics aggressively advertised to patients that they should get frequent skin checks.

Current guidelines state that there is no strong evidence that regular screening of the general population reduced mortality from skin cancers. Regular checks are useful, however, for those with suppressed immune systems, a history of cancers, or extremely fair skin. The most effective way to detect cancers was for patients to monitor their own skin and to visit a doctor as soon as they noticed any changes.

“People think they need skin checks annually but cancers can grow and become fatal in a much shorter time than that,” Walker said. “Not all skin cancer clinics are the same, they are not all bad and they can serve an important purpose with a shortage of dermatologists, but there is a lack of consistency in training.”

The principal of a law firm specialising in medical law, Catherine Henry, said she first raised the issue a decade ago in a legal journal after seeing clients whose cancers had been mismanaged. She raised her concerns with government health departments but little had changed since then, she said.

“I am running a case at the moment for a man who is dying of melanoma and his case highlights how difficult diagnostically melanoma can be,” Henry said. “He visited a doctor many times about a lesion on his scalp but it was not treated. Fifteen months later he went to a different doctor who diagnosed melanoma but, by that stage, it had metastasised.

“Isn’t it time the federal government took a role in all of this and looked seriously at the levels of funding for more dermatologists? This is an issue of public safety.”

A spokesman for the health minister, Greg Hunt, said the commonwealth government was currently assessing an allocation of funding for specialist training places in rural areas, including in dermatology.

In response to claims skin cancer doctors were excising moles unnecessarily in order to claim benefits, he said; “The Department of Health conducts education and compliance activities to assist doctors meet their obligations and responsibilities, including that Medicare services are clinically relevant”.